OSTEOMYELITIS

LBSN-3Group 1

INTRODUCTION

• Osteomyelitis is infection in the bone.

• Osteomyelitis can occur in infants, children, and adults.

• Different types of bacteria typically affect the different age groups.

• In children, osteomyelitis most commonly occurs at the ends of the long bones of the arms and legs, affecting the hips, knees, shoulders, and wrists.

• In adults, it is more common in the bones of the spine (vertebrae) or in the pelvis.

STATISTICS

The incidence of osteomyelitis is approximately 2 in 10,000 people.

DEBRIDEMENT

• is the medical removal of a patient's dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.

• Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy, where certain species of live maggots selectively eat only necrotic tissue.

PATIENT’S PROFILE

Patient Profile

Demographic Data

Name: Patient x

Age: 20 years old

Date of Birth: July 17, 1991

Sex: Male

Civil Status: Single

Admitting medical Diagnosis: Osteomyelitis Femur Lift

GORDON’S ASSESSMENT

OVERVIEW

Symptoms and Signs of Osteomyelitis

Symptoms of osteomyelitis can vary greatly.

In children, osteomyelitis most often occurs more quickly.

They develop pain or tenderness over the affected bone, and they may have difficulty or inability to use the affected limb or to bear weight or walk due to severe pain.

In adults, the symptoms often develop more gradually. Other symptoms include fever,chills, irritability, swelling or redness over the affected bone, stiffness, and nausea.

Causes osteomyelitis

There are several different ways to develop osteomyelitis.

The first is for bacteria to travel through the bloodstream (bacteremia) and spread to the bone, causing an infection.

This most often occurs when the patient has an infection elsewhere in the body, such as pneumonia or a urinary tract infection, that spreads through the blood to the bone.

An open wound over a bone can lead to osteomyelitis.

An open fracturewhere the bone punctures through the skin is also a potential cause.

A recent surgery or injection around a bone can also expose the bone to bacteria and lead to osteomyelitis.

Patients with conditions or taking medications that weaken their immune system are at a higher risk of developing osteomyelitis.

These include patients with cancer, chronic steroid use, sickle cell disease, human immunodeficiency virus (HIV), diabetes, hemodialysis, intravenous drug users, and the elderly.

Causes, incidence, and risk factors

Bone infection can be caused by bacteria or fungi.

Infection may also spread to a bone from infected skin, muscles, or tendons next to the bone, as in osteomyelitis that occurs under a chronic skin ulcer (sore).

The infection that causes osteomyelitis can also start in another part of the body and spread to the bone through the blood.

A current or past injury may have made the affected bone more likely to develop the infection.

A bone infection can also start after bone surgery, especially if the surgery is done after an injury or if metal rods or plates are placed in the bone.

In children, the long bones are usually affected.

In adults, the feet, spine bones (vertebrae), and the hips (pelvis) are most commonly affected.

Risk factors

are recent trauma, diabetes, hemodialysis, poor blood supply, and IV drug abuse. People who have had their spleen removed are also at higher risk for osteomyelitis.

Treatment for Osteomyelitis

In many cases, osteomyelitis can be effectively treated with antibiotics and pain medications.

If a biopsy is obtained, this can help guide the choice of the best antibiotic.

In some cases, the affected area will be immobilized with a brace to reduce the pain and speed the treatment.

Sometimes, surgery may be necessary.

If there is an area of localized bacteria (abscess), this may need to be opened, washed out, and drained.

If there is damaged soft tissue or bone, this may need to be removed.

If bone needs to be removed, it may need to be replaced with bone graft or stabilized during surgery.

NURSING THEORIES

Environmental TheoryFlorence Nightingale

Nightingale believe that the environment was the major component of creating illness in a pt. she regarded disease as “ The reaction of kindly nature against the condition in w/c we have placed ourselves” and.

Her theory contains Three major Relationship.

1. Environment to pt.

2. Nurse to environment

3. Nurse to pt.

Goal Attainment TheoryImogene King

Kings model is composed of three interacting systems these are “Personal, interpersonal & Social communication”. These are used to establish a nurse-client relationship and utilized by the nurse to form a strong foundation for a dynamic and interaction environment.

King discuss the Three health needs of Human beings.

1. Need for Information

2. Need for care for Illness prevention and

3. Need for total care when a person doesn’t have the capacity to help themselve

The theory focuses on creating a positive behavior that can be adapted both by the nurse and client to achieve goals establish by the client with the help of nurse.

Self-Care Deficit Theory of NursingDorothea Orem

Self-Care

Self-Care is an activity that promotes a person’s well being. It is performed by the person who are aware of the time frames on behalf of maintaining life, continuing personal development and a healthy functional living.

Self-Care requisites

Are insights of action or requirements that a person must be able to meet and perform in order to achieve well being.

And there are two elements of self care requisites:

1. The factor to be controlled or manage to keep as aspect(s) of human functioning and development within the norms compatible with life health and personal well-being and;

2.The nature of the required action.

Developmental Self-Care Requisites

The following are actions to be undertaken that will provide developmental growth:

Provision of conditions that promote development

Engagement in self-development and:

Prevention of the effects of human conditions that are threatens life.

EFFECTS ON GROWTH AND DEVELOPMENT

Effects on Growth and Development

The Developmental Stages of Erik Erikson 

Young adulthood: 18 to 35

Ego Development Outcome: Intimacy and Solidarity vs. Isolation

Basic Strengths: Affiliation and Love

In the initial stage of being an adult we seek one or more companions and love. As we try to find mutually satisfying relationships, primarily through marriage and friends, we generally also begin to start a family, though this age has been pushed back for many couples who today don't start their families until their late thirties. If negotiating this stage is successful, we can experience intimacy on a deep level.

If we're not successful, isolation and distance from others may occur. And when we don't find it easy to create satisfying relationships, our world can begin to shrink as, in defense, we can feel superior to others.

Our significant relationships are with marital partners and friends.

To successfully develop the capacity for intimacy, young adults must learn to develop close, personal relationships with other people.

DIAGNOSTIC TESTS

Diagnostic tests

C- reactive protein

C-reactive protein (CRP) is a non-specific test. It is used by a doctor to detect inflammation if there is a high suspicion of tissue injury or infection somewhere in the body, but the test cannot tell where the inflammation is or what condition is causing it. CRP is not diagnostic of any condition, but it can be used together with signs and symptoms and other tests to evaluate an individual for an acute or chronic inflammatory condition.

may be used to detect or monitor significant inflammation in an individual who is suspected of having an acute condition such as:

A serious bacterial infection like sepsis or a fungal infection

What does the test result mean?

The level of CRP in the blood is normally low. 

A high or increasing amount of CRP in the blood suggests the presence of inflammation but will not identify its location or the condition causing it. In individuals suspected of having a bacterial infection, a high CRP suggests the presence of one. In people with chronic inflammatory conditions, high levels of CRP suggest a flare-up or that treatment has not been effective.

If the CRP level is initially elevated and drops, then it means that the inflammation or infection is subsiding and/or responding to treatment.

Hematology

Hematology, also spelled haematology, is the branch of internal medicine, physiology, pathology, clinical laboratory work, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases. Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases. The laboratology work that goes into the study of blood is frequently performed by a medical technologist. Hematologists physicians also very frequently do further study in oncology - the medical treatment of cancer.

Tests used in the investigation of hematological problems include:

Full blood count

Erythrocyte sedimentation rate (ESR)

Blood film

Bone marrow examination

Coombs test

Diascopy

serum Ferritin level

Vitamin B12 and Folate levels

Prothrombin time

Partial thromboplastin time

Protein electrophoresis

Hemoglobin electrophoresis

D-dimer

EOS

What does the test result mean?

A very high SED rate (ESR) may occur with giant cell arteritis, hyperfibrinogenemia (increased fibrinogen levels in the blood), multiple myeloma, macroglobulinemia - primary, necrotizing vasculitis or polymyalgia rheumatica.

Lower than normals levels may be due to congestive heart failure (CHF), hyperviscosity, hypofibrinogenemia (decreased fibrinogen levels), low plasma protein (due to liver or kidney disease), polycythemia or sickle cell anemia.

ESR (male): 0 - 15 mm/hrESR (female): 0 - 20 mm/hr

ESR (Erythrocyte Sedimentation Rate - It is a nonspecific screening test that indirectly measures how much inflammation is in the body. This test can be used to monitor inflammatory or cancerous diseases. It cannot be used to diagnose a specific disorder although it is used in detecting and monitoring tuberculosis, tissue death, certain forms of arthritis, autoimmune disorders and some inflammatory diseases.

An increased SED rate (ESR) may be due to anemia, kidney disease, osteomyelitis, pregnancy, rheumatic fever, rheumatoid arthritis, syphilis, systemic lupus erythematosus, thyroid disease, tuberculosis or other inflammatory conditions.

Complete Blood Tests (CBC)

The complete blood count or CBC test is used as a broad screening test to check for such disorders as anemia, infection, and many other diseases. It is actually a panel of tests that examines different parts of the blood and includes the following:

Red blood cell (RBC) count is a count of the actual number of red blood cells per volume of blood. Both increases and decreases can point to abnormal conditions.

Hemoglobin measures the amount of oxygen-carrying protein in the blood.

Hematocrit measures the percentage of red blood cells in a given volume of whole blood.

The platelet count is the number of platelets in a given volume of blood. Both increases and decreases can point to abnormal conditions of excess bleeding or clotting. Mean platelet volume (MPV) is a machine-calculated measurement of the average size of your platelets. New platelets are larger, and an increased MPV occurs when increased numbers of platelets are being produced. MPV gives your doctor information about platelet production in your bone marrow.

What does the test result mean?

Result Normal values

101.4 120-180

Hemoglobin

A low hemoglobin is referred to as anemia. There are many reasons for anemia.

Some other infrequent causes of elevated hematocrit are lung disease, certain tumors, a disorder of the bone marrow known as polycythemia rubra vera, and abuse of the drug erythropoietin (Epogen) by athletes for blood doping purposes.

What does the test result mean?

Result Normal values

0.299 0.37-0.54

Hematocrit

A low hematocrit is referred to as being anemic.

Some other infrequent causes of elevated hematocrit are lung disease, certain tumors, a disorder of the bone marrow known as polycythemia rubra vera, and abuse of the drug erythropoietin (Epogen) by athletes for blood doping purposes.

What does the test result mean?

Result Normal values

27.96 28-33

Mean Corpuscular Hemoglobin (MCH)

High MCH levels can indicate macrocytic anemia, which can be caused by insufficient vitamin B12. Insufficient folic acid can be another cause of macrocytic anemia.

This type of anemia can be caused by insufficient iron in the diet or by blood loss. Blood loss, such as what might occur with tumors in the colon and other parts of gastrointestinal tract, can cause low iron levels and a low MCH.

What does the test result mean?

Result Normal values

460 150-400

Platelet

High platelet values may be seen with bleeding, iron deficiency, some diseases like cancer, or problems with the bone marrow.

Low platelet values can occur in pregnancy or idiopathic thrombocytopenic purpura (ITP) and other conditions that affect how platelets are made or that destroy platelets.

MEDICATIONS

Medication

Cefazolin

Indication

Treatment of infections due to susceptable organisms including that of the respiratory tract, GUT, biliary tract, skin and skin structure, bone and joint, septicemia and endocarditis.

Contraindication

Hypersensitivity to cephalosporins

Special precaution

Penicillin sensitive patient, impaired renal function.

Adverse reaction

Skin rashes, urticaria, anaphylaxis.

Gentamicin

Indication

Treatment of severe systemic infections due to gm-ve and other organisms including biliary tract infections, brucellosis, cat scracth disease, cystic fibrosis, endocarditis, endometritis, gastroenteritis, meningitis, otitis media, pneumonia, skin infections and UTI.

Contraindication

History of hypersensitivity and toxic reractions to other aminoglycosides. Uncomplicated initial episodes of UTI.

Special precaution

MG, impaired renal function. Monitor renal, auditory and vestibular functions.

Adverse reaction

Ototoxicity and nephrotoxicity, rash, urticaria, itching, drug fever, anaphylactoid reactions.

Tramadol

Indication

Moderate to severe pain and post-op pain.

Contraindication

Acute alcohol intoxication. Hypnotics, centrally-acting analgesics, opoids or psychotropic drugs.

Special precaution

History of epilepsy, susceptibility to seizures, head injury, increased intracranial pressure, severe hepatic and renal impiarment, respiratory depression and shock.

Adverse reaction

Nausea, vomiting, diarrhea, constipition.flushing allergic reactions.

Ketorolac

Indication

Relief of ocular itching due to seasonal allergic conjunctivitis. Prophylaxis and associated symptoms after ocular surgery.

Special precaution

Bleeding tendencies, concomitant treatment which prolong bleeding time. Potential cross- sensitivity to acetylsalicylic acid, phenylacetic acid derivatives and other NSAIDS.

Adverse reaction

Transient stinging and burning on instillation, ocular irritation, allergic reactions.

Ranitidine

Indication

Peptic ulcer disease, GERD, prevention and treatment of GI bleeding due to stress ulcers, prevention and treatment of bleeding peptic ulcers.

Contraindication

Hypersensitivity. Presence of cardiac rhythm disturbances. Acute intermittent porphyria.

Special precaution

Gastric ulcers highly suspicious for malignancy, impaired renal and hepatic function.

Adverse reaction

Headache, malaise, dizziness, somnolence, constipation, diarrhea, muscular pain.

DISCHARGE PLANNING

What is discharge planning?

Medicare says discharge planning is "A process used to decide what a patient needs for a smooth move from one level of care to another." Only a doctor can authorize a patient's release from the hospital, but the actual process of discharge planning can be completed by a social worker, nurse, case manager or other person. Ideally, and especially for the most complicated medical conditions, discharge planning is done with a team approach.

M-edication

E-xercise

T-reatment

H-ealth teaching

O-ut patient

D-iet

S-piritual

Medication

Instructed immediate relatives to facilitate the patient to continue

Taking the drugs given to him on the right time and with the right dose to

Facilitate continuity of care.

Exercise

Encouraged immediate relatives to facilitate regular exercise such as Passive ROM exercise.

Treatment

Encouraged patient to have enough rest and comply to the physicians whenever health problems occur.

Health Teaching

encouraged and explained to him the benefits and advantages of proper hygiene to promote wellness.

Out Patient

Instructed patient to come back for follow up check up on the date ordered.

Diet

Advised patient to eat nutritional foods like fruits and vegetables. Eat a well balanced diet.

Spiritual

Encouraged patient to continue him habits in going to church every day and always seek God helps when ever problems occur. 

NURSING CARE PLAN

Nursing Care Plan

END.